ABSTRACT Although HIV care and treatment initiatives, as well as scale-up of prevention activities, have dramatically reduced HIV infection rates in much of sub-Saharan Africa (SSA), young women there experience among the highest HIV incidence rates in the world. Several programs have been launched to address the ongoing high HIV risk among AGYW in SSA. The most ambitious among them is the DREAMS initiative. This layered intervention package focuses on four areas: empowering AGYW and reducing their risk, reducing risk in their sexual partners, strengthening families, and mobilizing communities for change. The package also includes access to the critical biomedical intervention component Pre-Exposure Prophylaxis (PrEP). The potential effectiveness of oral antiretroviral medications to prevent the sexual acquisition of HIV (PrEP) has been well established in placebo-controlled, randomized clinical trials and open-label studies. In these trials, drug efficacy is dependent on adherence. No efficacy was seen in several studies among women where adherence to the drug was low. The existing tools to monitor PrEP adherence include self-report, pill count, electronic pill bottles, and PBMC?s. Currently the DREAMS program relies on health provider assessment which is inconsistently recorded and based on either self-report, pill count, or PrEP program persistence. A drug concentration is a more objective measure of adherence and closely correlates with the clinical outcomes of PrEP. In this study, we propose to collect dried blood spot specimens via finger stick to measure PrEP adherence by intracellular tenofovir-diphosphate level and evaluate concordance between the objective drug levels, self- reported adherence, and study persistence measures.